November 2019 Technician Class Licensing Course
Welcome to the Bear Bait Radio Club.

Please use this form to register for our next class to be held in the Town of Clay, November 16th and 17th, 2019.

Also PLEASE, register only one person per form. If you experience difficulty completing the form, you may register directly with the instructor, Scott Marriam, via email at

Deadline for registration is Saturday November 9, 6 PM.

Thank you.
Last Name *
Your answer
First Name *
Your answer
Email Address *
Your answer
Phone number *
Please provide a contact number in case of course cancellation or schedule change. Please include the area code and use the following format: (XXX) XXX-XXXX
Your answer
Mailing address *
House Number, Apt Number (if applicable) and Street
Your answer
City *
Your answer
State *
If your state isn't listed, please provide the 2 letter abbreviation for your state of residence.
Zip Code *
Your answer
Optional: Due to the lack of places to buy food nearby, lunch will be available for a small fee on both days.(Menu is normally pizza and wings one day, baked ziti the other.) Please check below as appropriate:
How did you hear about our course? *
So we can analyze the effectiveness of our advertising, please let us know how you found out about this course.
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